Monitoring Patient Safety in Health Care: Building the Case for Surrogate Measures

Background: Objective measurements are notably lacking for many adverse events in health care. A new approach to monitoring such events is based on the experience in measuring hospital-associated infections. Developing Objective and Universal Measures: An essential tenet of the current goal of surveillance-focusing only on rigorously confirmed adverse events-is neither necessary nor achievable across the entire health care system. Efforts should be directed instead to creating objective measures of quality of care and of outcomes that can be used by all health care facilities. Adopting objective measures would be easier if health care was open to surrogate measures of important outcomes. Surrogate measures of interest for infection surveillance are used to identify objective, readily ascertained events that are sufficiently correlated with infections to provide useful information about organizations' infection rates. For example, the surgical site infection rate following coronary artery bypass appears to correlate closely enough with the proportion of patients who receive extended courses of inpatient antibiotics to be a useful indicator of a hospital's outcomes for the procedure. Conclusion: Developing clinically relevant process or surrogate measures that clinicians would use to improve patient outcomes is essential. These measures could be relevant not only to hospital-acquired infections but other health care-related adverse events that are relatively common yet require substantial resources to identify.